Julie A Brown

RAND Corporation, Santa Monica, California, United States

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Publications (14)30.94 Total impact

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    ABSTRACT: There is widespread interest in assessing care coordination to improve overall care quality. We evaluated a five-item measure of care coordination included in the 2012 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey (n = 326,194 respondents, 46% response rate). This measure includes patient reports of whether their personal doctor discusses their medicines, has medical records and other relevant information, and is informed about care from specialists, and whether the patient gets help in managing care and timely follow-up on test results. A one-factor categorical confirmatory factor analytic model indicated that five items constituted a coherent scale. Estimated health-plan-level reliability was 0.70 at about 102 responses per plan. The composite had a strong unique association with the CAHPS global rating of health care, controlling for the CAHPS core composite scores. This measure can be used to evaluate relative plan performance and characteristics associated with better care coordination.
    Medical Care Research and Review 11/2013; · 3.01 Impact Factor
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    ABSTRACT: BACKGROUND: A doctor's ability to communicate effectively is key to establishing and maintaining positive doctor-patient relationships. The Consumer Assessment of Healthcare Providers and System (CAHPS(®)) Clinician and Group Survey is the standard for collecting and reporting information about patients' experiences of care in the USA. OBJECTIVE: To evaluate how well CAHPS(®) Clinician and Group 2.0 core and supplemental survey items (CG-CAHPS) with a 12-month reference capture doctor-patient communication. DATA SOURCES/STUDY SETTING: Eleven of the 40 highest-rated physicians on the CG-CAHPS survey treating patients in a Midwest commercial health plan. STUDY DESIGN: Data were obtained via semi-structured interviews. Specific behaviors, practices, and opinions about doctor communication were coded and compared to the CG-CAHPS items. PRINCIPAL FINDINGS: CG-CAHPS fully captures six of the nine behaviors most commonly mentioned by high-performing physicians: employing office staff with good people skills; involving office staff in communication with patients; spending enough time with patients; listening carefully; providing clear, simple explanations; and devising an action plan with each patient. Three physician behaviors identified as key were not captured in CG-CAHPS items: use of nonverbal communication; greeting patients and introducing oneself; and tracking personal information about patients. CONCLUSIONS: CG-CAHPS survey items capture many of the most commonly mentioned doctor-patient communication behaviors and practices identified by high-performing physicians. Nonverbal communication, greeting patients, and tracking personal information about patients were identified as key aspects of doctor-patient communication, but are not captured by the current CG-CAHPS. We recommend further research to assess patients' perceptions of specific verbal and nonverbal behaviors (such as leaning forward in a chair, casually asking about other family members), followed by the development of new items (if needed) that aim to capture what these specific behaviors represent to patients (e.g., listens attentively, seems to care about me as a person, empathy). We also recommend including items about greeting and tracking personal information about patients in future CAHPS item sets addressing doctor-patient communication. Enriching the content of the CAHPS communication measure can help health-care organizations improve doctor-patient communication and interactions.
    The patient 05/2013; · 1.57 Impact Factor
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    ABSTRACT: OBJECTIVE: To produce reliable and informative health plan performance data by race/ethnicity for the Medicare beneficiary population and to consider appropriate presentation strategies. DATA SOURCES: Patient experience data from the 2008-2009 Medicare Advantage (MA) and fee-for-service (FFS) CAHPS surveys and 2008-2009 HEDIS data (MA beneficiaries only). STUDY DESIGN: Mixed effects linear (and binomial) regression models estimated the reliability and statistical informativeness of CAHPS (HEDIS) measures. PRINCIPAL FINDINGS: Seven CAHPS and seven HEDIS measures were reliable and informative for four racial/ethnic subgroups-Whites, Blacks, Hispanics, and Asian/Pacific Islanders-at sample sizes of 100 beneficiaries (200 for prescription drug plans). Although many plans lacked adequate sample size for reporting group-specific data, reportable plans contained a large majority of beneficiaries from each of the four racial/ethnic groups. CONCLUSIONS: Statistically reliable and valid information on health plan performance can be reported by race/ethnicity. Many beneficiaries may have difficulty understanding such reports, however, even with careful guidance. Thus, it is recommended that health plan performance data by subgroups be reported as supplemental data and only for plans meeting sample size requirements.
    Health Services Research 04/2013; 48(2pt1):417-434. · 2.29 Impact Factor
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    ABSTRACT: This report describes the findings from a demonstration conducted by RAND with the Florida Medicaid program to test applications of Consumer Assessment of Health Plans Study (CAHPS) consumer reports in the Medicaid sector. In collaboration with the Florida Agency for Health Care Administration (AHCA), we designed both paper and computer-based report formats, which were tested in field applications in Volusia County, Florida. This demonstration was the first of RAND's CAHPS demonstrations. Results of this work have been applied in subsequent demonstrations with the New Jersey and Iowa Medicaid programs.
    11/2012;
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    ABSTRACT: The HCAHPS Survey obtains hospital patients' experiences using four modes: Mail Only, Phone Only, Mixed (mail/phone follow-up), and Touch-Tone (push-button) Interactive Voice Response with option to transfer to live interviewer (TT-IVR/Phone). A new randomized experiment examines two less expensive modes: Web/Mail (mail invitation to participate by Web or request a mail survey) and Speech-Enabled IVR (SE-IVR/Phone; speaking to a voice recognition system; optional transfer to an interviewer). Web/Mail had a 12% response rate (vs. 32% for Mail Only and 33% for SE-IVR/Phone); Web/Mail respondents were more educated and less often Black than Mail Only respondents. SE-IVR/Phone respondents (who usually switched to an interviewer) were less often older than 75 years, more often English-preferring, and reported better care than Mail Only respondents. Concerns regarding inconsistencies across implementations, low adherence to primary modes, or low response rate may limit the applicability of the SE-IVR/Phone and Web/Mail modes in HCAHPS and similar standardized environments.
    Medical Care Research and Review 11/2012; · 3.01 Impact Factor
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    ABSTRACT: : To complement a nursing home resident survey, the team developed a survey asking family members about their experiences with nursing homes. Although a family member does not receive care directly from a nursing home, their experiences at the nursing home and with staff can contribute to understanding nursing home quality. : To describe how the nursing home family member instrument was developed, refined, tested, and finalized. : The team developed a draft survey using information from a literature review, 12 focus groups with family members involved in choosing a nursing home for someone, review of nursing home surveys, and expert/stakeholder input. The survey went through 2 rounds of cognitive interviews (n=54) and revisions and was fielded in 15 nursing homes. Data from the pilot survey (n=885) were subjected to psychometric analyses to evaluate the measurement properties of items as well as the reliability and validity of the resulting composites. On the basis of these analyses and input from experts, the survey was finalized. : Focus groups and experts provided input into discerning important indicators of quality, although in some cases family members were not the best sources of information. Cognitive testing refined the survey and eliminated some of the proxy items. The field test analysis and input from experts eliminated 10 items. The final survey included 21 items organized into 4 composites. : This survey measures family members' experiences of nursing home care, and the results contribute to the understanding of quality of care in nursing homes.
    Medical care 11/2012; 50 Suppl:S20-7. · 3.24 Impact Factor
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    ABSTRACT: : To develop and evaluate survey questions that assess processes of care relevant to Patient-Centered Medical Homes (PCMHs). : We convened expert panels, reviewed evidence on effective care practices and existing surveys, elicited broad public input, and conducted cognitive interviews and a field test to develop items relevant to PCMHs that could be added to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group (CG-CAHPS) 1.0 Survey. Surveys were tested using a 2-contact mail protocol in 10 adults and 33 pediatric practices (both private and community health centers) in Massachusetts. A total of 4875 completed surveys were received (overall response rate of 25%). : We calculated the rate of valid responses for each item. We conducted exploratory factor analyses and estimated item-to-total correlations, individual and site-level reliability, and correlations among proposed multi-item composites. : Ten items in 4 new domains (Comprehensiveness, Information, Self-Management Support, and Shared Decision-Making) and 4 items in 2 existing domains (Access and Coordination of Care) were selected to be supplemental items to be used in conjunction with the adult CG-CAHPS 1.0 Survey. For the child version, 4 items in each of 2 new domains (Information and Self-Management Support) and 5 items in existing domains (Access, Comprehensiveness-Prevention, Coordination of Care) were selected. : This study provides support for the reliability and validity of new items to supplement the CG-CAHPS 1.0 Survey to assess aspects of primary care that are important attributes of PCMHs.
    Medical care 11/2012; 50 Suppl:S2-S10. · 3.24 Impact Factor
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    ABSTRACT: : Consumer assessment of health care is an important metric for evaluating quality of care. These assessments can help purchasers, health plans, and providers deliver care that fits patients' needs. : To examine differences in reports and ratings of care delivered to adults and children and whether they vary by site. : This observational study compares adult and child experiences with care at a large west coast medical center and affiliated clinics and a large mid-western health plan using Consumer Assessment of Healthcare Providers and Systems Clinician & Group 1.0 Survey data. : Office staff helpfulness and courtesy was perceived more positively for adult than pediatric care in the west coast site. In contrast, more positive perceptions of pediatric care were observed in both sites for coordination of care, shared decision making, overall rating of the doctor, and willingness to recommend the doctor to family and friends. In addition, pediatric care was perceived more positively in the mid-west site for access to care, provider communication, and office staff helpfulness and courtesy. The differences between pediatric care and adult care were larger in the mid-western site than the west coast site. : There are significant differences in the perception of care for children and adults with care provided to children tending to be perceived more positively. Further research is needed to identify the reasons for these differences and provide more definitive information at sites throughout the United States.
    Medical care 11/2012; 50 Suppl:S35-9. · 3.24 Impact Factor
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    ABSTRACT: Background: Little is known about whether health information technology (HIT) affects patient experiences with health care. Objective: To develop HIT questions that assess patients care experiences not evaluated by existing ambulatory Consumer Assessment of Health Plans and Systems (CAHPS) measures. Research Design: We reviewed published articles and conducted focus groups and cognitive testing to develop survey questions. We collected data, using mail and the internet, from patients of 69 physicians receiving care at an academic medical center and 2 regional integrated delivery systems in late 2009 and 2010. We evaluated questions and scales about HIT using factor analysis, item-scale correlations, and reliability (internal consistency and physician-level) estimates. Results: We found support for 3 HIT composites: doctor use of computer (2 items), e-mail (2 items), and helpfulness of provider's website (4 items). Corrected item-scale correlations were 0.37 for the 2 doctor use of computer items and 0.71 for the 2 e-mail items, and ranged from 0.50 to 0.60 for the provider's website items. Cronbach α was high for e-mail (0.83) and provider's website (0.75), but only 0.54 for doctor use of computer. As few as 50 responses per physician would yield reliability of 0.70 for e-mail and provider's website. Two HIT composites, doctor use of computer (P<0.001) and provider's website (P = 0.02), were independent predictors of overall ratings of doctors. Conclusions: New CAHPS HIT items were identified that measure aspects of patient experiences not assessed by the CAHPS C&G 1.0 survey.
    Medical Care 01/2012; 50(11). · 3.23 Impact Factor
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    ABSTRACT: Using data from 335,249 Medicare beneficiaries who responded to the 2007 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, along with data from 22 cognitive interviews, we investigated the reliability and validity of an instrument designed to assess beneficiaries' experiences with their prescription drug plans. Composite measures derived from the instrument had acceptable internal consistency and sufficient plan-level reliability to inform consumer choice, quality improvement, and payor oversight. These measures were positively associated with members' overall rating of the plan and their willingness to recommend the plan. Moreover, each was independently useful in predicting beneficiaries' global ratings of their plan. This instrument can be an important tool for helping beneficiaries to choose a plan that best meets their needs.
    Health care financing review 02/2009; 30(3):41-53. · 2.06 Impact Factor
  • Kimberly A Hepner, Julie A Brown, Ron D Hays
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    ABSTRACT: The medical group survey from the CAHPS (formerly Consumer Assessment of Health Plans Study) project, G-CAHPS, focuses on patient experiences in receiving care from their medical group practice. We compared mail and telephone responses to the G-CAHPS survey in a sample of 880 patients from four physician groups. Patients were randomly assigned to mode. Analyses included comparison of response rates, missing data, internal consistency reliability of six multi-item scales, and mean scores. A total of 537 phone completes and 343 mail completes were obtained (54% response rate). There were no significant differences in internal consistency by mode. In addition, there was only one significant mode difference in item and composite means by mode of administration after adjusting for case-mix differences. This study indicates that mail and telephone modes of data collection for the G-CAHPS survey produce similar results.
    Evaluation &amp the Health Professions 01/2006; 28(4):377-89. · 1.48 Impact Factor
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    ABSTRACT: While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown. Telephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES). Scores were estimated using items asking the proxy perspective (6 items from the SF-12, 10 items from a UI scale, and all 10 FES items). Proxy and patient scores were compared using intraclass correlation coefficients (ICC, one-way model). Variables associated with absolute agreement between patients and proxies were explored. Patients had a mean age of 81 years (range 75-93) and 67% were female while proxies had a mean age of 70 (range 42-87) and 49% were female. ICCs were 0.63 for the SF-12, 0.52 for the UI scale, and 0.29 for the FES. Proxies tended to understate patients' general health and incontinence concern, but overstate patients' concern about falling. Proxies who lived with patients and those who more often see patients more closely reflected patient FES scores compared to those who lived apart or those who saw patients less often. Internal consistency reliability of proxy responses was 0.62 for the SF-12, 0.86 for the I-QOL, and 0.93 for the FES. In addition, construct validity of the proxy FES scale was supported by greater proxy-perceived fear of falling for patients who received medical care after a fall during the past 12 months (p < .05). Caution should be exercised when using proxies as a source of information about older patients' health perceptions. Questions asking about proxies' views yield suboptimal agreement with patient responses. However, proxy scales of UI and fall concern are internally consistent and may provide valid independent information.
    Health and Quality of Life Outcomes 01/2005; 3:75. · 2.27 Impact Factor
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    ABSTRACT: To assess the effects of CAHPS health plan performance information on plan choices and decision processes by New Jersey Medicaid beneficiaries. The study sample was a statewide sample of all new Medicaid cases that chose Medicaid health plans during April 1998. The study used state data on health maintenance organization (HMO) enrollments and survey data for a subset of these cases. An experimental design was used, with new Medicaid cases randomly assigned to experimental or control groups. The experimental group received a CAHPS report along with the standard enrollment materials, and the control group did not. The HMO enrollment data were obtained from the state in June 1998, and evaluation survey data were collected from July to October 1998. No effects of CAHPS information on HMO choices were found for the total sample. Further examination revealed that only about half the Medicaid cases said they received and read the plan report and there was an HMO with dominant Medicaid market share but low CAHPS performance scores. The subset of cases who read the report and did not choose this dominant HMO chose HMOs with higher CAHPS scores, on average, than did those in an equivalent control group. Health plan performance information can influence plan choices by Medicaid beneficiaries, but will do so only if they actually read it. These findings suggest a need for enhancing dissemination of the information as well as further education to encourage informed choices.
    Health Services Research 09/2002; 37(4):985-1007. · 2.29 Impact Factor
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    ABSTRACT: The focus of the literature review is consumer assessment of providers at the medical group level. The Internet provides access to a range of searchable databases. Without a search strategy, however, untold hours may be spent scouring different, sometimes overlapping bibliographies. For this reason, we devised a systematic search strategy to ensure a quality and comprehensive search. Time limits and other constraints on the search helped to combat diminishing returns. Thorough documentation is the best guarantee that references are not lost or unnecessarily duplicated. To maintain quality control in our literature review, we documented not only the reference of interest, but also any information about the search path that led to the reference. This helped to retrospectively analyze the comprehensiveness of our search and allows for the reproducibility of the search results. For each iteration of the literature search, we recorded the following information: (a) database searched, (b) key words and search option combinations, (c) specific organization or WWW site, (d) years used for the search, (e) number of returned references per search, and (f) number of selected references per search.
    08/2000;